POS1226 CARDIOVASCULAR RISK IN PATIENTS WITH MYOSITIS COMPARED TO THE GENERAL POPULATION
Authors: S. Oreska, H. Štorkánová, J. Kudlicka, V. Tuka, O. Mikeš, Z. Krupičková, M. Satny, E. Chytilova, J. Kvasnicka, M. Spiritovic, B. Heřmánková, P. Cesak, M. Rybar, K. Pavelka, L. Šenolt, H. Mann, J. Vencovský, M. Vrablik, M. Tomčík
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Cardiovascular (CV) risk due to accelerated atherosclerosis and impaired metabolism can be increased in idiopathic inflammatory myopathies (IIM) on behalf of systemic inflammation, limited mobility, and glucocorticoid therapy. <h3>Objectives</h3> This study aimed to evaluate CV risk in patients with IIM in comparison to healthy controls (HC) and to assess its association with disease-specific features. <h3>Methods</h3> 90 patients with IIM (70 females; mean age 56.6; mean disease duration 5.95 years; dermatomyositis: n=29, polymyositis: n=12, immune-mediated necrotizing myopathy (IMNM): n=20, anti-synthetase syndrome: n=29) and 180 HC (130 females, mean age 54.3) were included. In both groups, subjects with a history of CV disease (angina pectoris, myocardial infarction, cerebrovascular, and peripheral arterial vascular events) were excluded. Muscle involvement, disease activity, and tissue damage were evaluated (by MMT-8, MITAX, MDI, respectively). Comorbidities and current treatment were recorded. All participants underwent examinations of carotid intima-media thickness (CIMT), pulse wave velocity (PWV), ankle-brachial index (ABI), and body composition (by densitometry (DXA) and bioelectrical impedance analysis (BIA)). The risk of fatal CV events was evaluated by the Systematic COronary Risk Evaluation (SCORE, charts for the European population) and its modifications: SCORE multiplied by the coefficient 1.5 (mSCORE), and SCORE2. <h3>Results</h3> Compared to HC, IIM patients had a significantly higher prevalence of traditional CV risk factors, carotid artery disease (CARD), abnormal ABI, and PWV (p&lt;0.05 for all). After propensity score matching (PSM) using traditional CV risk factors, the prevalence of CARD and pathologic PWV remained significantly higher in IIM than HC (p&lt;0.05 for all), but no significant difference in SCORE was observed. Overall CV risk based on calculated risk (modifications of SCORE) and ultrasound (US) examinations was comparable between IIM ad HC after PSM (CVR-SCORE p=0.457, CVR-SCORE2 p=0.130, CVR-US p=0.126). IMNM patients had the most unfavorable CV risk profile among IIM subtypes. The calculated CV risk scores by SCORE and SCORE2 (in both IIM and HC), and mSCORE (in IIM only) were reclassified according to CIMT and the presence of carotid plaques. SCORE was demonstrated to be the most inaccurate in predicting CV risk in IIM, while there was a significantly higher proportion of reclassified patients with underestimated CV risk evaluated by SCORE compared to SCORE2 and mSCORE (p=0.020). Age, disease activity, lipid profile, body composition parameters, and blood pressure were the most significant predictors of CV risk in IIM patients (p&lt;0.05 for all variables in bivariate analysis). Moreover, the length of glucocorticoid therapy was positively associated with an increased count of carotid plaques and overall CV risk estimated by US examination (p&lt;0.05 for both). <h3>Conclusion</h3> This cross-sectional cohort study in IIM patients demonstrated a significantly increased risk of subclinical atherosclerosis and CV risk, and also an increased prevalence of traditional CV risk factors compared to HC with comparable age and gender distribution. The most unfavorable findings were seen in patients with IMNM. All scoring systems for CV risk screening underestimated the CV risk in IIM when using the CV risk according to ultrasound findings. SCORE2 appeared to be the most accurate tool in IIM. <h3>Acknowledgements</h3> Supported by MHCR (023728; NV18-01-00161A; NU21-01-00146). <h3>Disclosure of Interests</h3> None Declared.